Assessing the implementation of India's new health reform program, Ayushman Bharat, in two Southern states: Kerala and Tamil Nadu

• Published date: 01 March 2023
• Author: Kalyani Pillai,Iyabo Obasanjo
• Date: 01 March 2023
• DOI: http://doi.org/10.1002/wmh3.535

Received: 23 March 2021

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Revised: 30 October 2021

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Accepted: 26 April 2022

DOI: 10.1002/wmh3.535

ORIGINAL ARTICLE

Assessing the implementation of India's new

health reform program, Ayushman Bharat, in

two Southern states: Kerala and Tamil Nadu

Kalyani Pillai |Iyabo Obasanjo

Department of Health Sciences, College of

William and Mary, Williamsburg,

Virginia, USA

Correspondence

Iyabo Obasanjo, Department of Health

Sciences, College of William and Mary,

Williamsburg, VA, USA.

Email: iobasanjo@wm.edu

Abstract

India's health indicators are negatively impacted by the

high percentage of out‐of‐pocket expenditures, which

leaves many unable to access health care or impov-

erishes them. To improve this situation, the Indian

government in 2018, as part of health a reform program

called Ayushman Bharat Initiative (AB), started the

Pradhan Mantri Jan Arogya Yojana (PMJAY) as a

scheme to provide financial access to secondary and

tertiary healthcare services for people living in poverty.

The AB‐PMJAY is a publicly‐funded insurance program

that provides over $6,000 per indigent family per year for

in‐patient hospital care. We compare the rollout of the

program in two Indian States, Kerala and Tamil Nadu,

which have relatively better health indicators compared

with other Indian States. Questionnaires were developed

for the two states based on the separate programs they

had ongoing before AB‐PMJAY was introduced and the

differing implementation strategy they undertook. We

interviewed 21 health workers (10 from Kerala and 11

from Tamil Nadu), at the frontline of implementation and

analyzed the narrative of the answers given for related

themes. We found that low reimbursement rates may

limit the number of private hospitals participating in the

program, and that the classification criteria for eligibility

may need to be updated. We also found that differing

political alignment between the central government and

subregional governments may affect how well the

program is implemented. Overall, interview subjects felt

that the program would lead to better health care access

for the poor if well implemented and sustained.

KEYWORDS

health reform, Kerala, Tamil Nadu

World Medical & Health Policy. 2023;15:6–20.wileyonlinelibrary.com/journal/wmh36

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